Dr. Sunil Kalia
Chair of the Sun Awareness Working Group of the Canadian Dermatology Association
Dr. Melinda Gooderham
Canadian Dermatology Association member, Assistant Professor at Queen’s University
Understanding what vitiligo is, risk factors and the available treatment options can help patients with the condition find relief.
Vitiligo is an autoimmune skin condition which causes white patches on the body due to the loss of cells that produce the pigment melanin, responsible for skin, hair, and eye color. This autoimmune skin condition cannot be cured, but different treatments are available to help manage and improve the evenness of skin color. Vitiligo affects an estimated 0.5 to 2 percent of the general population. While the condition is seen in all races, it is more noticeable in people with deeper skin tones (e.g., brown, and black). Vitiligo can start at any age, but about half of those with the condition develop it before age 20, and about 95 percent before age 40.
Vitiligo affects an estimated 0.5 to 2 percent of the general population.
Vitiligo is believed to be caused by a combination of genetic and environmental factors. It can be associated with other autoimmune diseases such as hyper or hypothyroidism (having an over or underactive thyroid gland), rheumatoid arthritis, Type 1 diabetes, psoriasis, systemic lupus erythematosus, and pernicious anemia (subnormal red blood cell levels caused by an inability to absorb vitamin B12).
How does vitiligo affect people?
“As one of my mentors, Dr. Harvey Lui has said, ‘vitiligo is an optical disease’. Vitiligo does not directly affect a person’s health, but it is the visual appearance that psychosocially bothers individuals. The sharp contrast of having white skin compared to the normal skin color is what psychologically bothers individuals,” said certified dermatologist Dr. Sunil Kalia, Chair of the Sun Awareness Working Group of the Canadian Dermatology Association, and incoming president of the Photodermatology Society.
“Vitiligo can cause feelings of self-consciousness, low self-esteem, and anxiety due to the visible skin depigmentation,” said certified dermatologist, Dr. Melinda Gooderham, an Assistant Professor at Queens University, and consultant physician at the Peterborough Regional Health Centre.
Understanding the signs and symptoms
- Milky-white, irregularly shaped patches on the skin, especially on sun-exposed areas (face, hands, feet, arms, legs).
- These patches can also commonly occur or spread to the armpit, groin, around the mouth, eyes, nostrils, navel, and genital and rectal areas.
- Premature whitening or greying of hair on the scalp, eyelashes, eyebrows, or beard.
- Color loss in the mucus membranes inside the mouth and nose.
What are the treatment options?
“Although there is no cure for this autoimmune condition, there are treatments that can help to repigment affected skin, or in severe cases, depigment skin that is not affected to result in overall uniformity of skin colour,” said Dr. Gooderham.
“In Canada, most patients are still treated with topical steroid therapy, topical calcineurin inhibitors and phototherapy. These treatment options are safe and well tolerated. However, some patients may not respond to therapies, especially on certain body sites, such as the hands and feet. Since these are exposed sites, patients do want these areas clear of vitiligo,” said Dr. Kalia
“It is encouraging to see that there are many vitiligo treatment options in the pipeline with JAK inhibitors likely being approved and available to be used in Canada in the next year. For widespread disease, systemic treatment options may be given, but these can have more side effects. Transplant surgery can be used to restore the pigmentation”, added Dr. Kalia.
Commonly used treatment options to restore pigmentation
Topical corticosteroid therapy
Corticosteroid creams or ointments applied directly to the skin can help restore skin color. This is the most common treatment given to vitiligo patients. Corticosteroids can be used along with a topical vitamin D derivative, and results may be seen as early as three months. In some cases, corticosteroids may be given orally when the disease is active early on, but this is not recommended as a long-term treatment.
Topical calcineurin inhibitors
Another treatment for vitiligo uses non-steroid topical immunomodulators such as tacrolimus and pimecrolimus to regulate the local immune system activities resulting in the loss of pigment. These prescription medications have been shown to be more effective when used on vitiligo that affects the face. They can be used for longer periods without the side effects of corticosteroids.
Phototherapy
Narrow-band UVB light is administered up to three times a week. This treatment is simpler and may be safer than previous forms of ultraviolet therapies. This treatment may be done at either a physician’s office, or a home unit phototherapy device can be purchased.
JAK inhibitors
A new class of drugs known as Janus kinase inhibitors are showing great promise as a potential new treatment for vitiligo when applied to the skin as a cream. This class is also not a steroid and can be used safely in all areas for prolonged periods of time.
Transplant Surgery
A small percentage of vitiligo patients may be eligible for skin transplant surgery but is only performed at a few centres across Canada. Three options for surgical treatment are available:
- “Minipunch” skin transfer: This method uses the person’s own tissue to treat small patches.
- Blister grafting: This process uses heat, cold or suction to produce blisters over pigmented and depigmented skin. The tops of the pigmented blisters are removed and transplanted to the depigmented skin areas.
- Autologous melanocyte transplant: In this procedure, a sample of normal pigmented skin is isolated in a laboratory dish containing a special cell suspension solution. Once enough normal cells have been isolated, they are transplanted to depigmented areas of the skin.
Is vitiligo contagious?
Vitiligo is not contagious. You cannot develop vitiligo by touching or being close to somebody with the condition or sharing their utensils or food.
Is vitiligo more dangerous for people with dark skin?
“Vitiligo is not more dangerous for people with dark skin. However, since vitiligo is primarily an “optical disorder” usually it is more noticeable in individuals with darker skin. Therefore, the white discolorations are usually more bothersome psychologically,” said Dr. Kalia.
“Vitiligo can affect all skin tones and is not more dangerous in darker skin, however, people with darker skin tones or those facing cultural biases may experience unique challenges in coping with vitiligo, as the condition’s increased visibility in darker skin can lead to heightened self-esteem issues and stigmatization having a greater impact on quality of life,” said Dr. Gooderham.
Will my vitiligo go away?
There is currently no cure for vitiligo, but there are several approaches that can help repigment, mask or lessen its effect. While the spread of vitiligo may stop for several months or years, it can reoccur at any time, with this cycle repeating throughout one’s lifetime. Sometimes some areas of skin may regain pigment spontaneously.
Your Certified Dermatologist is a skin health expert. To learn more about vitiligo and treatment options, visit dermatology.ca.
